Cardiothoracic ICU

I started a new clinical rotation this week.  It's at a nearby trauma center working with a NP in the cardiothoracic ICU.  The unit is a 30 bed shared ICU- medical ICU and cardiothoracic ICU.
There are 3 cardiothoracic surgeons who average about 4-5 cases/day.  So far, the patients I have seen have been post-op aortic valve replacement (AVR), aortic root repair, coronary artery bypass graft (CABG) and total arch repair of a type A aortic dissection.

This clinical has taken me back to my days as a nurse working in a busy cardiothoracic ICU.  Some days I enjoyed being a 'heart' nurse and some days it was just too stressful and physically exhausting.  It also didn't help that the ICU intensivist was a former cardiothoracic surgeon and one of the grumpiest and most miserable people you'll ever meet.  Nope- don't miss it.

Working in the unit as a NP student is much different and I'm enjoying it.  The NP on this service was a former RN on the unit and when she graduated, the surgeons offered her this position.  She is very good at her job.  The ICU intensivist and a ICU fellow are always around for extra help or back-up when needed, which is also wonderful.

Although, I must say that I do miss the warmth and friendliness of the people I worked with at Christiana hospital in the neuro ICU.  It's funny how traveling only an hour south can make such a difference.  Ah-- gotta love the east coast. 

image from: laurencecooper.wordpress.com

Pocket Guide- a health risk?

(My apologies for the poor image- a few technical difficulties)

I recently purchased this pocket guide for my next rotation.  Before I ripped into the package, I read the warning on the plastic wrap.  Wow! I have never seen this kind of warning label on anything I have purchased before, especially a book.  Amazon did fail to disclose this potentially fatal health hazard in the description. 

'WARNING: THIS PRODUCT CONTAINS A CHEMICAL KNOWN TO THE STATE OF CALIFORNIA TO CAUSE CANCER AND BIRTH DEFECTS OR OTHER REPRODUCTIVE HARM.'

Well, I decided to take my chances.  I'll be carrying this green book of kryptonite with me on my next clinical rotation- a combined Medical ICU/Cardiothoracic ICU.

Who knew that becoming a health care professional could be hazardous to your health?

Time Magazine Article

Some of you may have already read this incredibly comprehensive article about the state of our health care system.  Steven Brill does a great job of exposing the various reasons for our astronomical cost of health care in this country.  The article is lengthy but worth your time.  Warning-- it will anger you.

Getting pimped

 Oh yes, that's right-- my favorite part of my neuro ICU rotation.  No seriously, it is.  Let me explain. 

There is nothing that motivates me more to know my stuff than when an attending is asking me question after question after question about a patient, medical condition, lab work, etc.  Luckily, the attendings in this neuro ICU are not as brutal as I have witnessed back in my days as a nurse working at a trauma center in Austin, Texas (how I miss that city).  I remember med students and residents getting eaten alive in front of a small audience-- so painful to watch. 

The 'pimping' that occurs on this rotation isn't nearly as severe as it could be.  Today I was asked to perform a neuro exam on a patient while the attending observed and asked questions about the cranial nerves I was testing, motor strength, sensory, etc.  I feel I did decent job- not perfect- but pretty good.  She then proceeded to ask pointed questions about the patient, diagnosis, etc. 

For all of you out there just dying to know the components of a neuro exam here they are:

Elements of the Neuro Exam:
1.  Level of consciousness; mental status
2.  Cranial Nerves
3.  Motor: strength, bulk and tone
4.  Sensory
5.  Reflexes


Easy right?  Try doing it in front of a small audience. 

Looking forward to the 'pimp zone' tomorrow.

A little Wharton and Penn insight

My husband graduated from Wharton's Executive MBA program a few years ago.  It was a crazy time in our lives.  He was working long hours at his normal job and then on weekends and weeknights he would attend class, study or meet with his group.  We thought that having our 3rd kid halfway through the program was in ingenious idea (3 kids in 3 yrs almost to the day).  I was still working as an ICU nurse in Philly and taking the required pharmacology class in the NP program.  We soon realized that we were going to or had already lost our minds.  I quit my job, took a few semesters off from the program and stayed at home full time to quell the madness within our four walls.  I loved it and it was the only way our family would have survived all of the demands we placed on ourselves. 

Ok- I digress- now what was the point of this?  Oh yeah- it's to share an article from Knowlege @ Wharton. It's a great article which discusses the issue of independent NP practice and it's economic impact. 


Quote from the article:

"Physicians may be facing a losing battle. "That horse has already left the barn," says Linda Aiken, professor of nursing at the University of Pennsylvania School of Nursing and director of the Center for Health Outcomes and Policy Research. "With Obamacare coming in and millions of people getting insurance, there is no other way to provide them with reasonable access in the short term except to expand the role of NPs and physician assistants (PAs). It takes 20 years to train a doctor, so there isn't any alternative." According to an article titled, "Broadening the Scope of Nursing Practice," published in 2011 in The New England Journal of Medicine, "between three and 12 nurse practitioners can be educated for the price of educating one physician, and more quickly."
"Doctors have always been wary of others poaching on their turf," says Lawton R. Burns, Wharton professor of health care management. "And highly trained nurses are always looking for more recognition, responsibility and autonomy rather than being under a physician's thumb. It's these types of dynamics that pose a challenge to health care reform."


Things are getting heated, people.  Thoughts?

Aneurysm Coiling

 Image via Yale Medical Group

Last week I had the opportunity to observe an endovascular aneurysm coiling performed by a neuro interventionalist. 

I've always wanted to check out the happenings in interventional radiology and this was such a cool procedure to watch. 

I sported the full lead apron including a thyroid collar.  The apron must weigh at least 7 lbs and weighs significantly more after hours of wear. 

The procedure was fascinating.  The coolest part for me were the 3D images that were produced in real time of the cerebral arteries.  The images looked something like this:

 Image via radiologycasereports.net

It was also interesting to watch the platinum coils being deployed into the aneurysm.  I am still fascinated by how a metal coil/coils into a weak portion of a cerebral artery works- but it does. 

I spoke at length with one of the NP's that works for the practice and she only had wonderful things to say about her role.  She sees patients both in the inpatient and outpatient setting.  Her schedule includes 4 10 hr days one week and then 3 10 hr days the next.  In my brief interactions with the physicians, they seem wonderful to work for and she agreed.  Sounds like a pretty good gig to me.

First job offer

I was in clinical yesterday and as I was leaving, the neuro/critical care attending offered me a position in their Neuro ICU when I graduate.  I was flattered.  We talked a bit more about the position but did not go into details.  This job would be a perfect fit, except that it is a 45 minute drive from where I currently live and that would be the limiting factor. 

As I've gone through NP school I've sometimes questioned my ability to function as a NP.  I've done well in school and know that my bedside experience has been incredibly valuable, but sometimes I doubted my ability. 

I was admittedly nervous about starting clinical but after several weeks of working in the unit I can really see myself feeling comfortable working as a NP.  I know I still have a lot  to learn and I recognize my limitations but I no longer doubt my ability to practice, safely and competently.  It is a great feeling.  Above all, I am so glad I chose the NP route.  I am happy with my career choice and know that I will enjoy my job once I graduate. 

Alright-- we're off heading out for a weekend of skiing.  Wish us luck-- it will be the first time for our kids. 

Have a wonderful weekend!

image: skiing wallpaper